您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (3): 61-66.doi: 10.6040/j.issn.1671-7554.0.2020.1125

• 临床医学 • 上一篇    下一篇

帕金森病患者脑动脉多普勒测定指数及血清表皮生长因子与动脉硬化和认知障碍的关联分析

李宁1,王翠兰2,张玉荣1   

  1. 1.济南市第三人民医院神经内科, 山东 济南 250132;2.山东大学齐鲁医院神经内科, 山东 济南 250012
  • 发布日期:2021-04-06
  • 通讯作者: 王翠兰. E-mail:qlyywcl@163.com

Association analysis of cerebral artery Doppler index and serum EGF level with arteriosclerosis and cognitive impairment in 60 patients with Parkinsons disease

LI Ning1, WANG Cuilan2, ZHANG Yurong1   

  1. 1. Department of Neurology, The Third Hospital of Jinan, Jinan 250132, Shandong, China;
    2. Department of Neurology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Published:2021-04-06

PDF (PC)

156

摘要： 目的 分析60例帕金森病(PD)患者脑动脉多普勒测定指数及血清表皮生长因子(EGF)水平与动脉硬化和认知障碍的关联性。 方法 选取2017年6月至2019年12月期间收治的60例PD患者,根据是否存在脑动脉硬化分为硬化组(22例)、非硬化组(38例),另选60名同期健康体检者作为对照组。所有受试者均行经颅多普勒超声(TCD)检测,采用酶联免疫吸附法测定所有受试者血清EGF,采用蒙特利尔认知评估量表(MoCA)评估认知情况。比较各组受试者间大脑基底动脉(BA)、大脑中动脉(MCA)的搏动指数(PI)、阻力指数(RI)以及血清EGF水平,采用Spearman分析MoCA总分与超声指标和血清EGF的相关性,Logistic回归分析与PD认知功能障碍相关的危险因素。 结果 3组受试者BA、MCA的RI、PI差异显著,其中硬化组的RI、PI均高于非硬化组、对照组(F=5.244, 9.745, 4.674, 10.465; P=0.007, <0.001, 0.011, <0.001)。3组受试者血清EGF水平、MoCA评分差异显著,其中硬化组各指标均显著低于非硬化组、对照组,非硬化组显著低于对照组,差异有统计学意义(F=54.289,38.788; P<0.001)。Spearman相关性分析结果显示,MoCA评分与BA、MCA的RI、PI呈负相关(r=-0.402, -0.436, -0.422, -0.477,P<0.05),与血清EGF水平呈正相关(r=0.667,P<0.05)。单因素分析结果显示,脑动脉硬化(P=0.016)、BA(P<0.001, P<0.001)和MCA(P=0.005, P=0.003)的RI、PI以及EGF(P<0.001)与认知功能障碍相关(P<0.05)。二元Logistic回归分析显示,脑动脉硬化(OR:2.361,95%CI:1.247~3.907)、MCA的RI(OR:1.988,95%CI:1.025~3.855)、PI(OR:2.489,95%CI:1.086~5.703)以及血清EGF(OR:0.312,95%CI:0.168~0.580)均为PD患者认知功能障碍的独立危险因素(P<0.05)。 结论 BA、MCA的PI、RI以及血清EGF与PD患者脑动脉硬化和MCI存在相关性,其中MCA的PI、RI、血清EGF以及脑动脉硬化是PD患者认知功能障碍的独立危险因素。

关键词: 帕金森, 认知功能, 脑动脉硬化, 经颅超声多普勒, 表皮生长因子

Abstract: Objective To analyze the association of cerebral artery Doppler index and serum epidermal growth factor(EGF)level with arteriosclerosis and cognitive impairment in 60 patients with Parkinsons disease(PD). Methods A total of 60 PD patients treated during Jun. 2017 and Dec. 2019 were selected and divided into the arteriosclerosis group(n=22)and non-arteriosclerosis group(n=38). Another 60 healthy controls were enrolled as the control group. Transcranial Doppler(TCD)was performed in all subjects. Serum EGF level was measured with enzyme-linked immunosorbent assay. Cognitive status was assessed with Montreal Cognitive Assessment Scale(MoCA). The pulsatility index(PI)and resistance index(RI)of basilar artery(BA)and middle cerebral artery(MCA), and serum EGF level were compared among the groups. The correlation among the total MoCA score, Doppler index and serum EGF level was explored with Spearman analysis. Risk factors related to cognitive dysfunction of PD were analyzed with Logistic regression. Results The RI and PI of BA and MCA in the three groups were significantly different, among which the RI and PI of the sclerosis group were higher than those of the non-sclerosis group and the control group(F=5.244, 9.745, 4.674, 10.465; P=0.007, <0.001, 0.011, <0.001).There were significant differences in serum EGF levels and MoCA scores among the three groups, in which each index of the sclerosis group was significantly lower than that of the non-sclerosis group and the control group, the non-sclerosis group was significantly lower than that of the control group(F=54.289,38.788; P<0.001). Spearman correlation analysis showed that MoCA score was negatively correlated with RI and PI of BA(r=-0.402, -0.436, P<0.05), RI and PI of MCA(r=-0.422, -0.477, P<0.05), but positively correlated with serum EGF level(r=0.667, P<0.05). Univariate analysis showed that cerebral arteriosclerosis(P=0.016), RI and PI of MCA(P=0.005, P=0.003)and BA(P<0.001, P<0.001), and EGF(P<0.001)were associated with cognitive impairment(P<0.05). Binary Logistic regression analysis showed that cerebral arteriosclerosis(OR=2.361, 95%CI=1.247-3.907), RI of MCA(OR=1.988, 95%CI=1.025-3.855), PI of MCA(OR=2.489, 95%CI=1.086-5.703)and serum EGF(OR=0.312, 95%CI=0.168-0.580)were independent risk factors of cognitive dysfunction in PD patients. Conclusion PI and RI of MCA and BA as well as serum EGF level are correlated with cerebral arteriosclerosis and mild cognitive impairment in PD patients, among which PI and RI of MCA, serum EGF level and cerebral arteriosclerosis are independent risk factors of cognitive impairment in PD patients.

Key words: Parkinsons disease, Cognitive function, Cerebral arteriosclerosis, Transcranial ultrasound Doppler, Epidermal growth factor

中图分类号: 

  • R743.3
[1] 许峰, 姚晨, 李晓秋, 等. 微电极记录和宏刺激丘脑底核在脑深部电刺激术治疗帕金森病中的应用[J]. 中华神经外科杂志, 2017, 33(6): 578-581. XU Feng, YAO Chen, LI Xiaoqiu, et al. Application of microelectrode recording and macrostimulation of subthalamic nucleus in deep brain stimulation for treatment of Parkinsons disease [J]. Chinese Journal of Neurosurgery, 2017, 33(6): 578-581.
[2] Saltychev M, Bärlund E, Paltamaa J, et al. Progressive resistance training in Parkinsons disease: a systematic review and meta-analysis [J]. BMJ Open, 2016, 6(1): e008756.
[3] Alcauskas M, Galetta S. Editors note: olfaction and incident Parkinson disease in US white and black older adults [J]. Neurology, 2018, 90(20): 940-941.
[4] Iván G, Nieto A, Jesús N, et al. Mild cognitive impairment in Parkinsons disease: clustering and switching analyses in verbal fluency test [J]. J Int Neuropsychol Soc, 2017, 23(6): 1-10.
[5] 杨仁光.经颅多普勒及颈动脉超声联合应用于脑动脉硬化及脑梗死早期诊断中的临床意义[J].中国实用神经疾病杂志,2017, 20(9): 98-100. YANG Renguang. Clinical significance of transcranial Doppler and carotid ultrasound in early diagnosis of cerebral arteriosclerosis and cerebral infarction [J]. Chinese Journal of Practical Nervous Diseases, 2017, 20(9): 98-100.
[6] 叶剑虹, 容小明, 吕瑞妍, 等. 鼻咽癌放疗后放射性颞叶坏死患者的脑血管动脉硬化的临床研究[J]. 中华放射医学与防护杂志, 2018, 38(4): 273-277. YE Jianhong, RONG Xiaoming, LYU Ruiyan, et al. Study of radiation-induced cerebral vascular and carotid atherosclerosis in nasopharyngeal carcinoma patients with radiation-induced temporal lobe necrosis [J]. Chinese Journal of Radiological Medicine and Protection, 2018, 38(4): 273-277.
[7] 中华神经精神科杂志编委会. 脑动脉硬化症诊断标准[J]. 中华神经精神科杂志, 1988, 11(2): 128.
[8] Lim NS, Swanson CR, Cherng HR, et al. Plasma EGF and cognitive decline in Parkinsons disease and Alzheimers disease [J]. Ann Clin Transl Neurol, 2016, 3(5): 346-355.
[9] 中华医学会神经病学分会帕金森病及运动障碍学组,中国医师协会神经内科医师分会帕金森病及运动障碍专业.中国帕金森病的诊断标准(2016版)[J]. 中华神经科杂志, 2016, 49(4): 268-271.
[10] Nasreddine ZS, Phillips NA, Bédirian V, et al. The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment[J]. J Am Geriatr Soc, 2005, 53(4): 695-699.
[11] Broeders M, de Bie RM, Velseboer DC, et al. Evolution of mild cognitive impairment in Parkinson disease[J]. Neurology, 2014, 81(4): 346-352.
[12] Levin OS, Chimagomedova AS, Skripkina NA, et al. Nonmotor symptoms in vascular and other secondary parkinsonism [J]. Int Rev Neurobiol, 2017, 134(1): 1303-1334.
[13] Hao Q, Feldmann E, Balucani C, et al. A new transcranial doppler scoring system for evaluating middle cerebral artery stenosis [J]. J Neuroimaging, 2020, 30(1): 97-103.
[14] Vinciguerra L, Lanza G, Puglisi V, et al. Transcranial doppler ultrasound in vascular cognitive impairment-no dementia [J]. PLoS One, 2019, 14(4): e0216162.
[15] 李振光,于成勇,于占彩,等.血清表皮生长因子对帕金森病认知功能损害的预测价值[J].中国神经免疫学和神经病学杂志,2015,22(4):229-232. LI Zhenguang, YU Chengyong, YU Zhancai, et al. Predictive value of serum epidermal growth factor on cognitive impairment in Parkinsons disease[J].Chinese Journal of Neuroimmunology and Neurology,2015,22(4):229-232.
[16] 徐剑霞, 刘卫国, 华平,等. 帕金森病前驱期轻度认知功能障碍的临床特点及相关影响因素分析[J]. 中华神经医学杂志, 2020, 19(10):1001-1007. XU Jianxia, LIU Weiguo, HUA Ping, et al. The clinical characteristics and related influencing factors of mild cognitive impairment in the prodromal stage of Parkinsons disease[J]. Chinese Journal of Neuromedicine, 2020, 19(10):1001-1007.
[17] 荆京,孟霞,王安心, 等.多发颅内动脉粥样硬化性狭窄对轻型卒中和短暂性脑缺血发作早期卒中复发风险影响研究[J].中国卒中杂志, 2019, 14(6): 555-560. JING Jing, MENG Xia, WANG Anxin, et al. Effect of multiple intracranial atherosclerotic stenosis on the risk of recurrent stroke in patients with transient ischemic attack and minor stroke [J]. Chinese Journal of Stroke, 2019, 14(6): 555-560.
[18] 方传勤, 王娟娟, 杜艳群, 等. NIHSS/DWI-ASPECTS不匹配预测大脑中动脉供血区脑梗死早期神经功能恶化[J]. 中风与神经疾病杂志, 2019, 36(7): 628-631. FANG Chuanqin, WANG Juanjuan, DU Yanqun, et al. NIHSS/DWI-ASPECTS mismatch predicts early neurological deterioration in patients with middle cerebral artery cerebral infarction [J]. Journal of Apoplexy and Nervous Diseases, 2019, 36(7): 628-631.
[19] Jiang QW, Wang C, Zhou Y, et al. Plasma epidermal growth factor decreased in the early stage of Parkinsons disease [J]. Aging Dis, 2015, 6(3): 168-173.
[1] 张秀芳,李沛铮,张博涵,孙丛丛,刘艺鸣. 生长分化因子15在LPS诱导的帕金森病模型中的保护作用及机制[J]. 山东大学学报 (医学版), 2022, 60(5): 1-7.
[2] 赵海龙,王皓,方雨晴,毛飞,赵张宁,田祥奇,徐新荣,王敏,李秀华. 增服艾地苯醌对34例帕金森病抑郁患者的疗效观察[J]. 山东大学学报 (医学版), 2022, 60(4): 38-44.
[3] 宋洛卿,周国钰,叶翔,卢梅,赵新静. 脑淀粉样血管病相关炎症长期误诊1例报道并文献复习[J]. 山东大学学报 (医学版), 2022, 60(4): 119-122.
[4] 刘丽雯,马俊,李沛铮,张秀芳,刘艺鸣. 128例帕金森病照料者负担及影响因素[J]. 山东大学学报 (医学版), 2022, 60(4): 45-49.
[5] 赵慧文,许琳,单姗,赵秀兰. 牛磺酸对1-溴丙烷致大鼠认知功能障碍的保护作用[J]. 山东大学学报 (医学版), 2022, 60(2): 14-21.
[6] 于书卷,王美娟,陈丽,曹英娟,吕晓燕,刘雪燕,林鹏,颜景政. 老年2型糖尿病患者轻度认知功能障碍的影响因素[J]. 山东大学学报 (医学版), 2022, 60(11): 108-112.
[7] 李湘青,殷欣,赵雪莲,赵培庆. NK细胞亚群CD56bright在帕金森患者外周血中的表达及临床意义[J]. 山东大学学报 (医学版), 2021, 59(2): 34-40.
[8] 孔文程,徐广润,贾俊丽,崔新宇. 脑腱黄瘤病1例并文献复习[J]. 山东大学学报 (医学版), 2021, 59(11): 72-75.
[9] 杨雪梅,李娟,王一凡,李培龙,王允山,杜鲁涛,王传新. 3-lncRNAs预后模型在HER2阳性乳腺癌预后评价中的意义[J]. 山东大学学报 (医学版), 2020, 58(5): 69-76.
[10] 高奎,万广宁,宋晓鹏,信波. 吡咯替尼治疗曲妥珠耐药HER2阳性乳腺癌1例[J]. 山东大学学报 (医学版), 2020, 58(12): 117-120.
[11] 张晓韬,何天齐,朱梅佳,唐吉友,赵张宁,毛飞,方雨晴,刘小民,马高亭,张小雨,张霄,王敏,李秀华. 艾地苯醌联合治疗帕金森病疗效的临床观察[J]. 山东大学学报 (医学版), 2019, 57(4): 34-41.
[12] 张晓倩,孟祥水,任庆国,南晓敏,安盼盼,帅欣艳,夏晓娜,王璇. 磁共振波谱成像对检测非痴呆型血管性认知障碍的探讨[J]. 山东大学学报 (医学版), 2019, 57(4): 42-46.
[13] 宋立敏,鲁珊珊, 王大伟,吕鑫,高原,唐吉友. 慢性失眠患者睡眠结构与注意力、记忆的相关性[J]. 山东大学学报 (医学版), 2019, 57(4): 52-58.
[14] 王建丽,王筱静,孙玉莲,胡晓乐,栾晓嵘. 吉非替尼联合化疗治疗50例晚期非小细胞肺癌患者的疗效[J]. 山东大学学报 (医学版), 2019, 57(11): 20-26.
[15] 徐淑媛,纪全江,国丽. 血清sEGFR、CEA及Cyfra21-1水平对非小细胞肺癌患者预后的影响[J]. 山东大学学报 (医学版), 2019, 57(10): 107-111.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 郑敏,郝跃伟,刘雪平,赵婷婷. 血小板膜糖蛋白Ibα基因HPA-2、Kozak序列多态性与脑梗死的相关性研究[J]. 山东大学学报(医学版), 2008, 46(3): 292 -295 .
[2] 张杰,李振华,孙晋浩,暴丽华,刘岳鹏. 恒定磁场对Schwann细胞氧化损伤的保护作用[J]. 山东大学学报(医学版), 2007, 45(3): 229 -232 .
[3] 方英立,马玉燕,刘锡梅,周文 . 急诊剖宫产患者围手术期替硝唑合理应用[J]. 山东大学学报(医学版), 2007, 45(10): 995 .
[4] 姜红菊,李润智,王营,徐冬梅,张梅,张运,李继福 . 冠状动脉粥样硬化斑块形态及介入治疗与MMP-9的关系[J]. 山东大学学报(医学版), 2008, 46(10): 966 -970 .
[5] 王术芹,齐 峰,吴剑波,孙宝柱. 罗哌卡因对大鼠离体主动脉收缩作用的钙离子调节机制[J]. 山东大学学报(医学版), 2008, 46(8): 773 -776 .
[6] 滕学仁,赵永生,胡光亮,周伦,李建民 . 两种方法保存同种异体髌腱移植重建膝关节交叉韧带的光镜电镜观察[J]. 山东大学学报(医学版), 2008, 46(10): 945 -950 .
[7] 袁吴敏,赵志伦,王洁贞 . 吸烟和饮酒与颅内肿瘤关系的Meta分析[J]. 山东大学学报(医学版), 2006, 44(11): 1146 -1149 .
[8] 赵鹏,毕万利,李宁 . 螺旋CT后处理技术对青少年先天性脊柱畸形的诊断价值[J]. 山东大学学报(医学版), 2007, 45(8): 825 -829 .
[9] 焦芳芳,刘世青,李飞,李长生,王琴,孙青,鹿伟 . 化瘀理肺方对大鼠肺间质纤维化时Smad7和TGF-β表达的影响[J]. 山东大学学报(医学版), 2007, 45(10): 1054 -1058 .
[10] 赵瑛，颜磊，张辉，于鹏，李明江，赵兴波. 精子相关抗原9在卵巢浆液性上皮肿瘤中的表达[J]. 山东大学学报(医学版), 2012, 50(2): 98 .
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发